Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT PROPATEN 7MM DIA 60x80CM

Facility

$13,635.00

Service Code	HCPCS C1768
Hospital Charge Code	270673929
Hospital Revenue Code	278
Min. Negotiated Rate	$328.60
Max. Negotiated Rate	$6,817.50
Rate for Payer: Aetna Commercial	$5,181.30
Rate for Payer: Aetna Medicare Advantage	$4,090.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,476.93
Rate for Payer: Cigna Commercial	$6,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,999.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25
Rate for Payer: UnitedHealthcare Community & State	$328.60
Rate for Payer: Wellpoint Medicaid Managed Care	$361.33

GRAFT PURAPLY AM 2x4

Facility

$4,750.00

Service Code	HCPCS Q4196
Hospital Charge Code	270676738
Hospital Revenue Code	636
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$1,149.50
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

GRAFT PURAPLY AM 2x4

Facility

$4,750.00

Service Code	HCPCS Q4196
Hospital Charge Code	270676738
Hospital Revenue Code	636
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

GRAFT PUTTY STIMUBLAST 10 CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688462
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

GRAFT PUTTY STIMUBLAST 10 CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688462
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GRAFT REGENERATIVE INJECTABLE

Facility

$6,200.00

Hospital Charge Code	270644027
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,500.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,364.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

GRAFT REGENERATIVE INJECTABLE

Facility

$6,200.00

Hospital Charge Code	270644027
Hospital Revenue Code	278
Min. Negotiated Rate	$149.42
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,364.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$149.42
Rate for Payer: Wellpoint Medicaid Managed Care	$164.30

GRAFT REM RG 6MM 30CM RSX70CM

Facility

$3,930.00

Hospital Charge Code	270655749
Hospital Revenue Code	278
Min. Negotiated Rate	$589.50
Max. Negotiated Rate	$951.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$951.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$864.60
Rate for Payer: Qualcare PPO/HMO/WC	$589.50

GRAFT REM RG 6MM 30CM RSX70CM

Facility

$3,930.00

Hospital Charge Code	270655749
Hospital Revenue Code	278
Min. Negotiated Rate	$94.71
Max. Negotiated Rate	$1,965.00
Rate for Payer: Aetna Commercial	$1,493.40
Rate for Payer: Aetna Medicare Advantage	$1,179.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,002.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,002.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$786.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,002.15
Rate for Payer: Cigna Commercial	$1,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$951.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$864.60
Rate for Payer: Qualcare PPO/HMO/WC	$589.50
Rate for Payer: UnitedHealthcare Community & State	$94.71
Rate for Payer: Wellpoint Medicaid Managed Care	$104.14

GRAFT REPAIR SPINE DEFECT

Facility

$13,276.00

Service Code	HCPCS 63710
Hospital Charge Code	1600000808
Hospital Revenue Code	360
Min. Negotiated Rate	$319.95
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,044.88
Rate for Payer: Aetna Medicare Advantage	$3,982.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,385.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,385.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,385.38
Rate for Payer: Cigna Commercial	$6,638.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,982.80
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.40
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$319.95
Rate for Payer: Wellpoint Medicaid Managed Care	$351.81

GRAFT REPAIR SPINE DEFECT

Facility

$13,276.00

Service Code	HCPCS 63710
Hospital Charge Code	1600000808
Hospital Revenue Code	360
Min. Negotiated Rate	$1,991.40
Max. Negotiated Rate	$1,991.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.40

GRAFT RESORBABLE BEAD KIT 25CC

Facility

$6,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270644028
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,500.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,364.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

GRAFT RESORBABLE BEAD KIT 25CC

Facility

$6,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270644028
Hospital Revenue Code	278
Min. Negotiated Rate	$149.42
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,364.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$149.42
Rate for Payer: Wellpoint Medicaid Managed Care	$164.30

GRAFT RESTORE GF 2.0 CC

Facility

$8,500.00

Service Code	HCPCS Q4100
Hospital Charge Code	270694055
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

GRAFT RESTORE GF 2.0 CC

Facility

$8,500.00

Service Code	HCPCS Q4100
Hospital Charge Code	270694055
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFT SEMITENDINOSUS

Facility

$9,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270679270
Hospital Revenue Code	278
Min. Negotiated Rate	$234.97
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$234.97
Rate for Payer: Wellpoint Medicaid Managed Care	$258.38

GRAFT SEMITENDINOSUS

Facility

$9,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270679270
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

GRAFT SEMITENDINOSUS 7.5x240

Facility

$9,750.00

Hospital Charge Code	270677526
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

GRAFT SEMITENDINOSUS 7.5x240

Facility

$9,750.00

Hospital Charge Code	270677526
Hospital Revenue Code	278
Min. Negotiated Rate	$234.97
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$234.97
Rate for Payer: Wellpoint Medicaid Managed Care	$258.38

GRAFT SEMITENDINOSUS TENDON FF

Facility

$10,000.00

Hospital Charge Code	270701868
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

GRAFT SEMITENDINOSUS TENDON FF

Facility

$10,000.00

Hospital Charge Code	270701868
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT SEMI TENDOSIS W/GRACILI

Facility

$8,615.00

Hospital Charge Code	270656926
Hospital Revenue Code	278
Min. Negotiated Rate	$1,292.25
Max. Negotiated Rate	$2,084.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,084.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,895.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,292.25

GRAFT SEMI TENDOSIS W/GRACILI

Facility

$8,615.00

Hospital Charge Code	270656926
Hospital Revenue Code	278
Min. Negotiated Rate	$207.62
Max. Negotiated Rate	$4,307.50
Rate for Payer: Aetna Commercial	$3,273.70
Rate for Payer: Aetna Medicare Advantage	$2,584.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,196.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,196.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,196.82
Rate for Payer: Cigna Commercial	$4,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,084.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,895.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,292.25
Rate for Payer: UnitedHealthcare Community & State	$207.62
Rate for Payer: Wellpoint Medicaid Managed Care	$228.30

GRAFT SKIN CARRIER

Facility

$2,858.25

Hospital Charge Code	270662746
Hospital Revenue Code	272
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$1,429.12
Rate for Payer: Aetna Commercial	$1,086.13
Rate for Payer: Aetna Medicare Advantage	$857.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$728.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$728.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$728.85
Rate for Payer: Cigna Commercial	$1,429.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$857.48
Rate for Payer: Oxford Commercial	$571.65
Rate for Payer: Qualcare PPO/HMO/WC	$428.74
Rate for Payer: UnitedHealthcare Commercial	$571.65
Rate for Payer: UnitedHealthcare Community & State	$68.88
Rate for Payer: Wellpoint Medicaid Managed Care	$75.74

GRAFT SKIN CARRIER

Facility

$2,858.25

Hospital Charge Code	270662756
Hospital Revenue Code	278
Min. Negotiated Rate	$428.74
Max. Negotiated Rate	$691.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$691.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$628.82
Rate for Payer: Qualcare PPO/HMO/WC	$428.74

Know your out-of-pocket cost for care.

All Charges